| NPI | 1356305023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD186427) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME0084094) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-10-24 |